# Cost-Effective Components of a Patient-Reported Symptom Monitoring System for Chemotherapy

## TL;DR

A study finds that a full electronic patient-reported outcome system with coaching and nurse follow-up is most cost-effective for managing chemotherapy symptoms.

## Contribution

The study identifies the most cost-effective components of an ePRO system for cancer patients undergoing chemotherapy.

## Key findings

- The complete ePRO intervention with self-management coaching and nurse follow-up was most cost-effective.
- The group with self-management coaching plus an activity tracker had the lowest cost-effectiveness.
- Comprehensive ePRO systems improve symptom control and are most cost-effective.

## Abstract

Which component or combination of components of an electronic patient-reported outcome (ePRO) system are most cost-effective for managing symptom burden in patients receiving chemotherapy?

In this economic evaluation including 757 participants randomized to 1 of 5 combinations of ePRO strategies, the complete ePRO intervention, including self-management coaching and nurse practitioner follow-up for severe symptoms, had the highest cost-effectiveness, while the group with self-management coaching plus an activity tracker had the lowest.

These findings suggest that comprehensive ePRO systems that integrate multiple intervention components offer the greatest value in terms of symptom control and cost-effectiveness.

This economic evaluation study evaluate which components or combinations of components of an electronic patient-reported outcomes system for adults with cancer receiving treatment was most cost-effective.

Electronic patient-reported outcome (ePRO) systems often combine a variety of components to manage and improve cancer symptom burden. While shown to reduce symptom severity, there are few studies that have assessed whether the included components are cost-effective.

To evaluate which components or combinations of components of Symptom Care at Home (SCH), an ePRO for adults with cancer receiving treatment, were most cost-effective.

This 5-group economic evaluation used data from a randomized clinical trial conducted from 2017 to 2020 across 2 cancer centers located in Utah and Georgia. Participants included adults with cancer starting a chemotherapy protocol. Data were analyzed from 2021 to 2024.

Participants were randomized into 1 of 5 groups receiving different combinations of the SCH intervention components, including automated self-management coaching and/or nurse practitioner (NP) follow-up. All groups completed daily ePRO symptom reporting across 11 symptoms and received at least 1 SCH component.

Cost-effectiveness was assessed using Markov simulation models and incremental cost-effectiveness ratios (ICERs) incorporating symptom burden, unplanned hospitalizations and emergency department visits, and SCH development and operational costs by group. Symptom burden was calculated as the summed symptom severity scores over the study period.

Among 757 adult participants (mean [SD] age, 59.2 [12.9] years; 463 [61.2%] female), 474 (62.6%) were married or partnered; 240 participants (31.7%) self-identified as Black, 29 participants (3.8%) as Hispanic, and 488 participants (64.5%) as White. In the base case analysis, 6-month total costs varied from $14 590 (NP follow-up with decision support) to $23 992 (NP follow-up only). The complete SCH intervention had the highest cost-effectiveness. The ICER for the complete SCH vs NP-only group was $4957. The complete SCH intervention had the highest probability of being cost-effective, at nearly all positive willingness-to-pay values, including very low thresholds.

This cost-effectiveness study of ePRO symptom management components found that the complete SCH intervention with all component parts was the most cost-effective treatment strategy. From a value-driven perspective, comprehensive ePRO systems both improve quality through reduced symptom burden and were most cost-effective.